29 June 2015

While we agree that there is
much work to be done in reforming clinical services, a healthy population
can best be achieved by looking beyond health care, focusing on prevention,
acting on the underlying causes of poor health and working with sectors outside
of health.

The Social Determinants of
Health Advocacy Network (SDoHAN) acknowledges that access to safe, quality,
timely and appropriate health care is important but this must not come at the
expense of recognising the long-term gains that can be made by investing in
prevention. If the Government doesn’t recognise prevention as a central goal,
the sustainability of its clinical services will be undermined.

In Tasmania there is a
preoccupation with hospitals, not health. Focusing more on preventive and
population health can reduce the frustration that many doctors feel in being
unable to address the underlying cause of many of the health problems they
encounter among their patients.

Members of the Social
Determinants of Health Advocacy Network (SDoHAN) work together to achieve
effective action on the social determinants of health in Tasmania. We believe
that all Tasmanians should have the opportunity to live a healthy life
regardless of their income, education, employment, gender, sexuality,
capabilities, cultural background, who they are or where they live.

We take a keen interest in
both strategic and local level initiatives to improve the health of Tasmanians.

We are disappointed that the
Government has chosen to make the development of its strategic plan for
preventive health in Tasmania a secondary priority and has not devised a more
comprehensive strategy that integrates preventative health at all levels of the
system.

We are also concerned about
whether the Government has any plans to undertake broad stakeholder engagement
or consultation in the development of its preventive health plan.

We offer the advice below to Government on how to make Tasmania the healthiest population in Australia by
2025.

Social Determinants of Health
Advocacy Network 2015

Supporting
Tasmanians to be the healthiest population in Australia

Whatever your preferred choice of
words, one thing is clear –

Health starts long before illness - it starts in our
everyday lives

Research shows that the houses we
live in, the transport we are able to access, the job we have or don’t have,
the social support we have around us and how much money we’ve got, have as much
impact on our health and wellbeing as our genes and behaviours.

What is also clear is that not everyone in Tasmania has the same
opportunity to be healthy. This isn’t fair. All Tasmanians should be able to
make the choices that allow them to live a healthy life, regardless of their
income, where they live, social position, education, gender, abilities or
cultural background.

It is time we expand the way we think about health and start where
health starts, not just where it ends. In Tasmania there is a preoccupation
with hospitals, not health. Hospitals should be a last resort not the first.1
It’s time to rethink health and include how to keep it, not just how to get it
back.

The
Social Determinants of Health Advocacy Network (SDoHAN) calls for action on the
following priority areas to help Tasmanians become the healthiest population.

Action #1:
Prioritise the early years

The
early childhood period (0-6 years) is considered to be the most important
developmental phase throughout the lifespan. Healthy early child development
strongly influences obesity, mental health, heart disease, competence in
literacy and numeracy, and economic participation throughout life. Investment
in early childhood development will pay for itself many times over.2

In
Tasmania we must do everything we can to give all children the best start in
life. We can do this by strengthening families and communities, providing comprehensive
support to families for the perinatal to three year period, building our public
education system, strengthening our aspirations for lifelong learning, and
reaching out to those who are at risk of falling behind.

Action #2:
Build a strong primary health system

The evidence is clear:
health systems oriented towards primary health achieve better health outcomes
for a lower overall cost than systems focused on specialist or tertiary care.
The international trend is to move away from hospital care towards more
community-based care.1 Primary health works with people in the
community throughout their life course and is concerned with action on the
social determinants of health and a preventive approach. It uses local approaches
and multidisciplinary teams. In Tasmania we need to strengthen our regionally
based community health centres and ensure that they operate within a
comprehensive primary health care framework.

Action #3: Establish
a government unit that works towards ‘Health for All Tasmanians’

We call on the Government to make ‘Health for All
Tasmanians’ a central goal. Giving all Tasmanians the same
opportunity to be healthy requires leadership and engagement across the
community.

A social determinants approach recognises that
action outside of the health system is required to establish the conditions
that promote good health and wellbeing and reduce our dependence on hospitals
and health care services. We need to get different sectors working together towards
this common purpose.

A sustainable government unit whose job it is to
provide leadership in this area is urgently needed. Such a unit would undertake
planning, build capacity and develop policies and programs that would give all
Tasmanians the opportunity to be healthy (i.e. working towards health equity). This unit would ensure that the
goal of Tasmanians being the healthiest Australians is prioritised across all
public policy.

Action #4: Embed
a social determinants of health approach throughout the health system

The work of the Tasmanian
health system should be driven by a desire to give all Tasmanians the best
opportunity to be healthy.

Every day our hospitals and health care providers see
patients with complex health needs that arise from a combination of biological,
psychological, social, economic and environmental factors. Many of these
patients are on a treadmill of treatment – presenting again and again to emergency
departments or other parts of the health care system with the same or related
problems – and costing millions of dollars. It is time to ‘break the cycle’ by
moving beyond an ineffective ‘fix them up
and move them on’ model to a more comprehensive integratedmodel of care that recognises the
broader determinants of health.4

Such a model would involve supporting patients along
their journey through the health care system and beyond, proactively engaging
services and supports along the way. It would involve identifying the
underlying reasons for poor health (such as inadequate housing, family
violence, poor education, unemployment, poor literacy, addiction and mental
health problems) and setting people up for success by
building ongoing treatment pathways that extend beyond traditional boundaries
of health care and place people at the centre of their care.

17 June 2015

Visit: http://thehothouse.net.au/the-ideas/ for the ideas that
came out of The Hothouse on Education. If you didn’t get to the forum last week
and would like to hear more about it visit: ABC Radio National's Life
Matters: http://abc.net.au/rn/lifematters

2. Arts Health Tasmanian Network

Networking
gatherings are held currently in the South but will be extended to other areas
of the state in the near future.

GUEST
PRESENTER - Associate Professor Ashley Lucas, Director of the Prison Creative
Arts Project, (PCAP) Theatre & Drama Department , University of Michigan.
For more information about the great work of PCAP visit the websites below.

This year marks 20 years since 189 countries signed the Beijing
Declaration and Platform for Action and committed to prioritisation of women’s
empowerment and gender equality. Yet a recently released UN analysis1 shows
that violence against women persists at “alarmingly high levels”. Worldwide,
one in three women reports sexual or physical violence from a male partner at
some point in their lifetime, and such experiences have been linked with
harmful effects on health, including maternal morbidity, poor mental health,
and vulnerability to HIV/AIDS.2 The UN report also contends that progress
towards gender equality has been slow.1 Effective and scalable interventions to
reduce intimate partner violence remain scarce, and questions remain about what
drives individual violence and why prevalence differs across settings and
countries. Lori Heise and Andreas Kotsadam’s study in The Lancet Global Health,
is thus very timely, and is a major advance in the understanding of worldwide
intimate partner violence. This analysis of data from 44 countries suggests
that gender inequality at the macro-level (ie, country-level) serves as a key
driver in women’s individual risk of violence and provides insight into why
prevalence of intimate partner violence varies across countries…

AbstractBackground
Gender inequality weakens maternal health and harms children through many
direct and indirect pathways. Allied biological disadvantage and psychosocial
adversities challenge the survival of children of both genders. United
Nations Development Programme (UNDP) has recently developed a Gender Inequality
Index to measure the multidimensional nature of gender inequality.
The global impact of Gender Inequality Index on the child mortality rates
remains uncertain.

Methods
We employed an ecological study to investigate the association between child
mortality rates and Gender Inequality Indices of 138 countries for which UNDP
has published the Gender Inequality Index. Data on child mortality rates
and on potential confounders, such as, per capita gross domestic product and
immunization coverage, were obtained from the official World Health
Organization and World Bank sources. We employed multivariate non-parametric
robust regression models to study the relationship between these variables.

Conclusions
We have documented statistically significant positive associations between GII
and child mortality rates. Our results suggest that the initiatives to curtail
child mortality rates should extend beyond medical interventions and
should prioritize women’s rights and autonomy. We discuss major pathways
connecting gender inequality and child mortality. We present the
socio-economic problems, which sustain higher gender inequality and child
mortality in LMICs. We further discuss the potential solutions pertinent to
LMICs. Dissipating gender barriers and focusing on social well-being of
women may augment the survival of children of both genders.

This article describes a framework and empirical evidence to support the
argument that educational programs and policies are crucial public health
interventions. Concepts of education and health are developed and linked, and
we review a wide range of empirical studies to clarify pathways of linkage and
explore implications. Basic educational expertise and skills, including fundamental
knowledge, reasoning ability, emotional self-regulation, and interactional
abilities, are critical components of health. Moreover, education is a
fundamental social determinant of health – an upstream cause of health.
Programs that close gaps in educational outcomes between low-income or racial
and ethnic minority populations and higher-income or majority populations are
needed to promote health equity. Public health policy makers, health
practitioners and educators, and departments of health and education can
collaborate to implement educational programs and policies for which systematic
evidence indicates clear public health benefits.

How to obtain this article click here. (Let
me know if you want to access this article but are unable via the link)

8. State of
inequality: reproductive, maternal, newborn and child health

The World Health Organization.

Published online: May 2015

Abstract

The health of the world’s population is in a state of inequality. That
is to say, there are vastly different stories to tell about a person’s health
depending on where they live, their level of education, and whether they are
rich or poor, etc. Monitoring the state of inequality in health takes into
account the current experiences of population subgroups, as well as the trends
of how health experiences in these subgroups have changed over time. This 2015reportdemonstrates best practices in reporting the results of
health inequality monitoring, and introduces innovative ways for audiences to
explore inequality data. Interactive data visualization components –
including story-points, equity country profiles, maps and reference tables –
accompany the key messages and findings of this report, allowing users to
customize data displays and engage in benchmarking according to their
interests. A series of feature stories indicated that inequalities in
reproductive, maternal, newborn and child health persist, despite having
narrowed over the past decade. There is still much progress to be made in
reducing inequalities in reproductive, maternal, newborn and child health
through equity-oriented policies, programmes and practices. Though the report
draws on data about reproductive, maternal, newborn and child health in low-
and middle-income countries, the approach and underlying concepts can be widely
applied to any health topic.

The Health inequality monitoring eLearning module is an overview
of health inequality monitoring, aiming to build theoretical and technical
capacity for health inequality monitoring across diverse settings and health
topics. This module introduces and explores the five general steps of
monitoring as they pertain to health inequality monitoring: selecting health
indicators and equity stratifiers, obtaining data, analysing data, reporting
results and implementing changes. A comprehensive applied example of health
inequality monitoring in the Philippines demonstrates how the concepts can be
applied in the context of low- and middle-income countries. This module is
presented in eight chapters, which are each followed by a number of quiz
questions and an application exercise. In each chapter, additional information
and examples are available to facilitate a more-thorough understanding of the
material. The entire module takes approximately four hours to complete, and is
not timed.

Contents:

Orientation

Chapter 1: Introduction

Chapter 2: Health indicators and equity
stratifiers

Chapter 3: Data sources

Chapter 4: Simple measures

Chapter 5: Complex measures

Chapter 6: Reporting inequalities I

Chapter 7: Reporting inequalities II

Chapter 8: Cumulative example

Resources

Acknowledgements

Note: This eLearning module is available in a standard format (with
audio), suitable for users with access to broadband internet, as well as in a
no-audio, low-bandwidth format.

14. Social determinants of health, inequality and
social inclusion among people with disabilities

Abstract

OBJECTIVE: to analyze the
socio-familial and community inclusion and social participation of people with
disabilities, as well as their inclusion in occupations in daily life.

METHOD: qualitative study with data
collected through open interviews concerning the participants' life histories
and systematic observation. The sample was composed of ten individuals with
acquired or congenital disabilities living in the region covered by a Family
Health Center. The social conception of disability was the theoretical framework
used. Data were analyzed according to an interpretative reconstructive approach
based on Habermas' Theory of Communicative Action.

RESULTS: the results show that the
socio-familial and community inclusion of the study participants is conditioned
to the social determinants of health and present high levels of social
inequality expressed by difficult access to PHC and rehabilitation services, work
and income, education, culture, transportation and social participation.

CONCLUSION: there is a
need to develop community-centered care programs in cooperation with PHC
services aiming to cope with poverty and improve social inclusion.

03 June 2015

1. Come and meet Tasmania’s new Commissioner for Children and join
him for a conversation about the social determinants of health

Wednesday
17 June 2015

10:00-11:30am

Hobart
Youth Arts & Recreation Centre

44
Collins Street, Hobart

Free
– all welcome

RSVP
(by 15 June) & enquiries:

socialdeterminantsofhealthtas@gmail.com

Social
Determinants of Health Advocacy Network

Mark
has worked for much of his career in the area of children and young people's
services and policy development. He is a committed advocate for young
people's rights. Having commenced his five year term in October 2014, Mark will
focus on the rights and interests of children, and the laws, policies and
programs that impact on them.

Mark
has had extensive experience in issues facing children and young people, having
worked with children from all types of backgrounds, including undertaking
significant work with vulnerable children. He has practical expertise in
child protection, child development, juvenile justice, children's services,
child care, disabilities, and early intervention and prevention services.
Mark has been a strong advocate for the importance of the social determinants
of health and wellbeing as a critical factor and consideration, in the
development of policy and service delivery.

2. The Hothouse on Education – some of us involved in this network were part
of Dark Mofo’s Hothouse this week.

Next
Thursday 11 June there is a forum in Hobart where they will present the ideas that
were developed. Everyone is welcome and it’s free. We encourage you to come
along if you can. http://thehothouse.net.au/the-forum/

The Social Determinants of Health Advocacy Network held its inaugural conference in Hobart last November

Visit our website to view and download some of the presentations

Visit: http://sdohtasmania.org.au

.

What are the social determinants of health?

The word social relates to society and means people.

Determinants of health are - broadly speaking - the things that affect your health - either in a positive way (they protect our health and keep us healthy) or a negative way (they make us sick).

If we put these things together - the social determinants of health are things (systems, products, factors) created, shaped and controlled by people that affect our health.

These things include education, housing, employment, transport and so forth. These are created and shaped by people. And because if this it's possible to change them.

As an example, let's look at transport. We - the people - have created our transport systems. Not necessarily you or I personally but as a society we've done this. The problem is that there are many aspects of the system that are not great - many of our streets aren't cycle or pedestrian friendly, if you live in a rural area public transport options are limited, the number of cars on our roads isn't good for the environment and so forth. All of these things about the transport system can affect our health.

But the great thing is that, because we - the people - developed this system in the first place, we have the ability to change it - to make things better and to improve health as a result.

There are other determinants of health - such as our genes - that we can't change. So let's focus on the things we can do to improve health.

More formally, here's how the literature talks about the social determinants of health:

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.

Here's a good place to start your reading:

A great publication on the social determinants of health is The Solid Facts.

Vision of the Network

All Tasmanians have the opportunity to live a long, healthy life regardless of their income, education, employment, gender, sexuality, capabilities, cultural background, who they are or where they live.

Membership

Membership of the Network is open to all Tasmanians who share this vision.

Membership is free of charge. Membership means you become a subscriber to our enews and that you get the opportunity to work with others who are part of this Network to undertake advocacy action.

Membership to the Network can be obtained by providing a name, organisation (where there is one but individuals can join as individuals), address, telephone and email address to the Facilitator by email:

socialdeterminantsofhealthtas@gmail.com

The Network currently has more than 220 members across Tasmania (as well as some interstate) from a broad range of sectors.

“The Commission’s main finding is straightforward. The social conditions in which people are born, live, and work are the single most important determinant of good health or ill health, of a long and productive life, or a short and miserable one. ……..This ends the debate decisively. Health care is an important determinant of health. Lifestyles are important determinants of health. ….But, let me emphasize, it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place”.

Dr Margaret Chan, Director General, World Health Organisation.

Tasmanian Action Sheets on the Social Determinants of Health

Visit the Tasmania Council of Social Service website to download 10 action sheets on the social determinants of health in Tasmania.